Sphincter of Oddi Manometry in a Community Hospital

Abstract

Purpose: Sphincter of Oddi dysfunction (SOD) is a relatively common disorder and is underrecognized in the community setting. Sphincter of Oddi manometry (SOM) is the accepted gold standard for diagnosis of SOD. SOM is usually utilized at a tertiary or university hospital. Reports in the community setting are limited since SOM is not widely available. We started offering SOM at our community hospital in December 2011. Objective: To retrospectively evaluate the technical success rate, and complications of SOM in the community setting. Methods: We performed ERCP with SOM on 64 patients between December 2011 and February 2013 at Silver Cross Hospital. There were 61 females. All of our patients were symptomatic and were suspected of having SOD type 3 or 2. Thirty eight patients had recurrent right upper quadrant pain. Twenty patients had recurrent idiopathic pancreatitis or epigastric pain with radiation to the back (pancreatic type pain). Six patients had epigastric and RUQ pain. All procedures were performed by one therapeutic endoscopist, who is fellowship trained in the procedure and has performed SOM at his previous institution. Only four nurses were trained in advanced endoscopy and SOM (the therapeutic team), and assisted with all the procedures. Lehman manometry catheter was used in all patients. Results: Successful cannulation of desired duct was achieved in 58 patients. Both ducts were cannulated and pressure measured in 48 patients. A pancreatic stent 5 F x 3 cm, 3 F x 8 cm, or 5 F x 5 cm was placed in 56 patients. Elevated pressures were found in 56 patients. Our overall success rate for desired duct was 90%. Success rate for dual duct manometry was 75%. Seven patients developed mild pancreatitis that subsequently resolved within 2-3 days. Two of these patients did not have pancreatic stent placed. In all 64 patients, there was no reported bleeding or perforation. Fifty nine patients followed-up; the symptoms had resolved in 47 patients, and improved in eight patients. Conclusion: SOM is not widely available and thus SOD is under diagnosed. Our preliminary data suggests that SOM can be safely and successfully performed in the community setting. The endoscopist and nursing staff need to be well trained, and have significant experience when performing SOM.